Femoral Hernia Presenting as Richter’s Variant: A Rare Case Report

Abstract

Background: Richter's hernia occurs when a portion of the anti-mesenteric border of a bowel wall is captured within the hernia sac, resulting in ischaemia, gangrene, and perforation. Only part of the circumference of the bowel wall is involved in Richter's hernia, which causes strangulation without obstruction. Femoral hernia presenting as a Richter’s hernia is rare. Aim: This is to report a case of Richter’s hernia in a femoral hernia occurring in an adult female. Case Report: In this case, a 62-year-old woman presented with a history of sudden generalized abdominal pain. Before the presentation, she had a six-year history of reducible left inguino-labial swelling that became irreducible two weeks ago. Pallor was present. Her temperature was 39.2°C, her pulse rate was 112 per minute, and her blood pressure was 132/62 mmHg. A diagnosis of a left femoral hernia was made. She was revived, and the groin swelling was explored through a midline incision over the abdomen. There was ischaemia of the anti-mesenteric border of the ileum, along with strangulated preperitoneal fat. The bowel vascularity over the anti-mesenteric border was doubtful, so a resection anastomosis of the segment of the bowel was done followed by a reduction of the bowel loop and herniorraphy. Conclusion: It is rare for a femoral hernia to present with a Richter's hernia, but it can happen even in the absence of obstructive symptoms. Any time there is groin swelling, it is important to get a quick, correct diagnosis and treatment. If there is a delay in identification and treatment, a spontaneous faecal fistula, an uncommon complication, may develop. The relevant authorities must address this as it reflects the status of healthcare in the developing world.